Exercise-Induced Bronchoconstriction (EIB)

If you start wheezing or coughing during exercise, or if physical exertion makes it difficult for you to breathe, you may have exercise-induced bronchoconstriction, or EIB (also known as exercise-induced asthma).

Exercise-Induced Bronchoconstriction (EIB) Management and Treatment

See an allergist for prescription medications, which may be more effective than over-the-counter treatments.

For more information on EIB management and treatment click here.

Symptoms

Exercise-induced bronchoconstriction, or EIB, is the preferred term for what was known for years as exercise-induced asthma. Symptoms develop when airways narrow as a result of physical exertion. EIB is caused by the loss of heat, water or both from the lungs during exercise as a result of quickly breathing in air that is drier than what is already in the body. As many as 90 percent of people with asthma also have EIB, but not everyone with EIB has asthma.

Symptoms typically appear within a few minutes after you start exercising and may continue for 10 or 15 minutes after you finish your workout. Anyone can experience these symptoms (especially someone who is out of shape), but with EIB, they are more severe than would be considered normal.

Diagnosing EIB

An allergist can determine whether your symptoms are exercise-induced alone, are a reaction to allergens or irritants in the air, or are an indication of underlying asthma. Wheezing in children after physical activity is often the first symptom of asthma.

As part of an examination, your allergist will take a history (including asking for information about any relatives with asthma or other breathing difficulties). You also may be asked for specific details about your physical activity, including where and how often you exercise. Your allergist will consider contributing or complicating conditions, such as upper-airway problems, that might play a role in your difficulties with exercise.

To check how exercise affects your breathing, your allergist may measure your breathing before, during and after you run on a treadmill or ride an exercise bike. During the test you will breathe into a tube that connects to a spirometer, a device that measures the volume of air being inhaled and exhaled.

In some cases, environmental factors may contribute to EIB. Skaters and hockey players may be affected by a combination of cold, dry air in ice rinks and pollutants from ice-resurfacing machines, while EIB in distance runners has been linked to exercising in high-allergen and high-ozone environments. In addition, indoor air with high levels of trichloramine, a chemical used in pool chlorination, has been linked to asthma and EIB in swimmers.

Management and Treatment

While it was thought for years that breathing cold air exacerbated EIB, more recent studies indicate that the dryness of the air, rather than the temperature, is the more likely trigger. Cold air typically contains less moisture than warm air, and quickly breathing dry air dehydrates the bronchial tubes, causing them to narrow and restrict airflow.

Before the 2010 Winter Olympics, The New York Times reported that as many as half of all elite cross-country skiers, and almost that many world-class figure skaters and hockey players, have been diagnosed with EIB.

Here are some suggestions to relieve symptoms of EIB:

Warm up with gentle exercises for about 15 minutes before you start more intense physical activity.

Cover your mouth and nose with a scarf or face mask when you exercise in cold weather.

Try to breathe through your nose while you exercise. This helps warm the air that goes into your lungs.

Sports and activities least likely to cause EIB symptoms:

Sports that require only short bursts of activity, including volleyball, gymnastics, baseball, wrestling, golf, swimming, football and short-term track and field events. Some swimming events can demand constant activity, but the warmth and humidity from the water make it easier for people with EIB to breathe.

Activities such as walking, hiking and recreational biking.

Sports and activities most likely to cause EIB symptoms:

Sports or activities that require constant activity or are done in cold weather, such as soccer, basketball, long-distance running, ice hockey, ice skating and cross-country skiing.

Two types of medicines used to treat asthma are prescribed to prevent and treat EIB symptoms. They are most frequently administered through an inhaler, although some are available in tablet form:

Short-acting inhaled beta2-agonists (bronchodilators) stop symptoms right away. They may be taken 15 to 30 minutes before vigorous exercise and generally prevent symptoms for two to four hours.

Long-term control asthma medicines are taken every day to prevent symptoms and attacks.

Inhaled corticosteroids. These help to relieve narrowing and inflammation of the bronchial tubes and are the most commonly prescribed type of long-term asthma medication. It may two to four weeks before these drugs reach their maximum effect.

Long-acting inhaled beta2-agonists (bronchodilators). Taken 30 to 60 minutes before exercise starts, these medications help prevent symptoms for 10 to 12 hours. They should be used only once within a 12-hour period, and they should be taken only in combination with an inhaled corticosteroid.

Elite athletes should check with the governing bodies of their sport about the medicines they are allowed to take to relieve their EIB or asthma symptoms. Another resource is the Prohibited List published by the World Anti-Doping Agency. Some medications (including, with some specific exceptions, beta2-agonists) are considered to be performance-enhancing drugs and cannot be used by athletes in competition unless a Therapeutic Use Exemption is granted for medical need.

If you continue to experience symptoms with exercise despite these recommendations, see your allergist to discuss what your next steps may be.